Tunde A. Alabi1,2* , Sonnen Atinge3, Chibuike Ejim4 and Samuel O. Adejoh5
1Department of Sociology, Faculty of Social Sciences, University of Lagos, Nigeria, 2Department of Sociology, Faculty of
Humanities, University of Cape Town, South Africa, 3Taraba State Health Services Management Board, Jalingo, Nigeria,
4Faith City Hospital, Lagos, Nigeria and 5Department of Social Work, Faculty of Social Sciences, University of Lagos, Nigeria
*Corresponding author. Email: taalabi@unilag.edu.ng
(Received 02 August 2020; revised 13 November 2020; accepted 13 November 2020; first published online 11 December 2020).
Abstract
Utilization of health care facilities for child delivery is associated with improved maternal and neonatal
outcomes, but less than half of mothers use these for child delivery in Nigeria. This study investigated
the factors associated with facility delivery in Nigeria, and their variation between the Northern and
Southern parts of the country – two regions with distinct socio-cultural make-ups. The study included
33,924 mothers aged 15–49 who had given birth in the last 5 years preceding the 2018 Nigeria
Demographic and Health Survey. Overall, higher age, being educated, being a Christian, being an urban
resident, being exposed to mass media, making joint decisions with partner on health care, beginning antenatal visits in the first trimester and attending antenatal clinics frequently were found to be associated with improved use of a health care facility for child delivery. An average mother in Northern Nigeria had a 38% chance of having a facility-based delivery, whereas the likelihood in the South was 76%. When other factors were adjusted for, age and listening to the radio were significant predictors of facility-based delivery in the South but not in the North. In the North, Christians were more likely than Muslims to have a facility-based delivery, but the reverse was true in the South. Rural women in the South had a 16% greater chance of having a facility-based delivery than urban women in the North. The study results suggest that there is inequality in access to health care facilities in Nigeria, and the differences in the socio-cultural makeup of the two regions suggest that uniform intervention programmes may not yield similar results across the regions. The findings give credence to, and expand on, the Cosmopolitan-Success and Conservative- Failure Hypothesis.
Keywords: Place of child delivery in Nigeria; Cosmopolitan-success and conservative-failure hypothesis; Spatial and health inequalities.
Introduction
Maternal mortality and morbidity are global public health concerns (Johnson et al., 2020). Over
500,000 women lose their lives each year during pregnancy and delivery, and the situation is worse
for women in poor countries compared with those from the developed nations (Piane, 2019), with
approximately 9 in 10 maternal mortality cases occurring in developing countries (WHO, 2019).
The rate of maternal deaths in sub-Sahara Africa is the highest globally, and accounts for approximately
two-thirds of all cases globally (WHO, 2019). In Nigeria, the rate of maternal deaths is 512
per 100,000 live births (NPC & ICF, 2019), while the neonatal mortality rate is 34 per 1000 live
births (UNICEF, 2016). Many maternal and neonatal deaths have been attributed to inadequate
use of maternal health care services (Ahuru, 2019; Adedokun & Uthman, 2019; Gebregziabher
et al., 2019; Sato et al., 2019; Johnson et al., 2020).
© The Author(s) 2020. Published by Cambridge University Press
Journal of Biosocial Science (2022), 54: 2, 163–183
doi:10.1017/S0021932020000747